Bilateral reticular white striae with erosive areas
52-year-old female
§Chief complaint
Soreness of both cheeks, worse with spicy food, for 6 months
§Medical & dental history
- 01Hypertension on an ACE inhibitor
- 02Hypothyroidism on thyroxine
- 03Several amalgam restorations, none directly adjacent to the worst lesions
§Clinical examination
- 01Bilateral symmetric lacy white striae on buccal mucosa (Wickham striae)
- 02Erosive erythematous area 12 mm on the left buccal mucosa
- 03Gingival desquamation in the lower anterior region
- 04Skin: violaceous flat-topped papules on the flexor wrist
§ figuresFigures (3)
Fig. 1Lichen planus-intra oral lesion
“Lichen planus-intra oral lesion” · Syed Wali Peeran · CC BY-SA 4.0 · Wikimedia Commons
Fig. 2Classic white striations of non-erosive lichen planus in the left buccal mucosa (left cheek)
“Lichen planus” · Ian Furst · CC BY-SA 4.0 · Wikimedia Commons
Fig. 3erosive lichen planus -Intra oral lesion
“Erosive lichen planus” · Syed Wali Peeran · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Lichen Planus figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Erosive oral lichen planus with cutaneous involvement
Bilateral symmetry plus Wickham striae plus classic wrist papules make this lichen planus rather than a lichenoid reaction, which is typically unilateral and drug- or amalgam-related.
§Investigations
- 01Incisional biopsy from a non-ulcerated striated area
- 02Direct immunofluorescence — shaggy fibrinogen at the basement membrane, excludes pemphigoid
- 03Fasting glucose and thyroid function
§Treatment plan
- 01Topical clobetasol 0.05 percent in orabase twice daily
- 02Antifungal prophylaxis during steroid use
- 03Avoid spicy and acidic triggers; meticulous plaque control
- 04Photographic monitoring; systemic steroids only for refractory disease
§Histopathology report
Hyperparakeratosis, saw-tooth rete ridges, basal cell liquefactive degeneration and a dense band-like lymphocytic infiltrate at the epithelial-connective tissue interface. Civatte bodies present. No dysplasia.
§Follow-up & outcome
- 01Symptomatic relief at 3 weeks; erosion healed by 8 weeks
- 026-monthly review — small but real malignant transformation risk (~1 percent)
§Clinical pearls / learning points
- 01Biopsy a striated area, not the ulcer floor — the diagnostic interface change is at the edge.
- 02Desquamative gingivitis is a clinical sign, not a diagnosis: lichen planus, MMP and pemphigus all cause it.
- 03Any lichen planus lesion that becomes indurated or nodular needs re-biopsy.
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L2 · Guideline — 1
- L3 · Systematic review — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Clinical Guidelines
Warnakulasuriya S, Kujan O, Aguirre-Urizar JM et al.. Oral diseases · 2021 · 27(8):1862-1880
WHO collaborating centre consensus on nomenclature and classification of oral potentially malignant disorders.
Systematic Reviews & Meta-Analyses
Cheng LL. The journal of evidence-based dental practice · 2022 · 22(2):101717
Meta-analysis quantifying the proportion of oral lichen planus cases undergoing malignant transformation.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- Neville BW et al. Oral and Maxillofacial Pathology, 5th ed.
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